How are hemolytic complement levels used in the differential diagnoses of acute poststreptococcal glomerulonephritis (APSGN)?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

The differential diagnosis of acute glomerulonephritis can be divided as follows (percentages indicate approximate frequency of C3 or hemolytic complement). [63]

Low serum complement level may indicate the following systemic diseases:

  • Systemic lupus erythematosus (SLE) (focal, 75%; diffuse, 90%)

  • Subacute bacterial endocarditis (90%)

  • Visceral abscess

  • "Shunt" nephritis (90%)

  • Cryoglobulinemia (58%)

Low serum complement level may indicate the following renal diseases:

  • Acute postinfectious glomerulonephritis (>90%)

  • MPGN: Type I (50-80%), type 2 (80-90%)

A normal serum complement level may indicate the following systemic diseases:

  • Polyarteritis nodosa group

  • Hypersensitivity vasculitis

  • Wegener granulomatosis

  • Henoch-Schönlein purpura

  • Goodpasture syndrome

A normal serum complement level may indicate the following renal diseases:

  • Immunoglobulin (Ig) A (or IgG-IgA) nephropathy

  • Idiopathic rapidly progressive glomerulonephritis (RPGN)

  • Anti-glomerular basement membrane (GBM) disease

  • Negative immunofluorescence findings

  • Immune complex disease


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